Explore Meniscus Injuries

Causes & Symptoms

What are meniscus injuries?

The menisci are a pair of crescent shaped shock absorbers that sit in between the femur and tibia (thigh-bone and shin-bone). There are two; the medial (the side closest to the other knee), and the lateral (closest to your outer leg). During activities on your feet, the meniscus dissipates the amount of strain on the surrounding articular cartilage, which is the layer on the ends of the bones. When the articular cartilage starts to wear down, this is often termed osteoarthritis.

The degree of meniscus injuries varies, ranging from minor degenerative fraying of the meniscus to displaced pieces of meniscus moving around the joint, or absence of part of the meniscus. The treatment for these are variable and to be determined by your healthcare provider.

Causes

The meniscus can tear either with an acute trauma (often a twisting or pivoting motion) or degeneratively when patients or athletes simply start to notice pain one day.

Symptoms

Symptoms of a meniscus injury typically involve pain on one or both sides of the knee. The patient or athlete may notice some swelling or fluid within the knee that can be recurrent with activities. A sense of something moving/catching or locking in the knee may be present. The patient will often have difficulty with twisting and lateral movements, as well as running and often squatting.

Diagnosis

Diagnosis of meniscus injuries is largely based on the history of the issue, which will be acquired from your healthcare provider, as well as a focused physical examination. X-ray films, particularly x-rays taken while standing, are beneficial to evaluate the integrity of the joint as a whole and to rule out other causes of discomfort. Advanced imaging can additionally be obtained, such as an MRI, to evaluate the meniscus itself further. Indications and interpretation of these results should be carried out exclusively by your healthcare provider.

Treatment

Nonsurgical Treatment

Nonsurgical treatment of meniscus injuries is common and often largely consists of:

  • Modifying activities, particularly of avoiding the activities that are troublesome, including pivoting and twisting activities and often running and going into a deep squatted position. These are often temporary until acute symptoms resolve
  • Keeping body weight at a healthy level is important as increased pounds on the body get directly distributed through the meniscus during weightbearing activities such as walking, running, stairs, etc.
  • Routine use of ice and/or heat can be used topically for a short duration to help alleviate symptoms
  • Oral anti-inflammatories (such as ibuprofen, naproxen, etc.) can be utilized which are designed to calm down the pain producing parts of the knee secondary to conditions such as meniscus tearing
  • Physical therapy, particularly in the setting of a degenerative meniscus tear, has been shown to have good success rates to help the muscles and other structures support the knee and reduce the strain on the meniscus. Learning an appropriate home exercise program here is important
  • Different types of injections can be considered, including but not limited to cortisone (a strong anti-inflammatory), platelet rich plasma (PRP), hyaluronic acid (“viscosupplementation”, often known as ‘lubricant injections’), and others. You can talk with your healthcare provider about the indications as well as the potential benefits, risks, and complications of each
  • There are a variety of different braces that can be used to try to provide some support

Surgical Treatment

Surgical treatment for meniscus tears are based on each individual patient's case. There are a variety of different types of meniscus tears and associated conditions which may further indicate or not indicate different types of surgeries. In general, a surgeon would perform one of three meniscus surgeries: Trimming the meniscus, repairing the meniscus, or putting in a new meniscus.

Meniscectomy (Meniscus Trimming): The most common of meniscus surgeries is to simply trim back the torn portion of the meniscus and leave behind as much of the fully functioning meniscus as possible. For meniscus tears, this is the most common technique performed, nearly 90% of the time according to some studies. This generally is day surgery where you go home the same day. Crutch use it is usually optional and often for a couple of days. Physical therapy as well as home exercises are common for the first month after the surgery. Typical return to full activity is 4-6 weeks.

Meniscus repair: Meniscus repairs are typically performed in certain patterns of tears and in certain locations. It is important to understand the indications, success rates, and potential complications of these types of procedures. This procedure is most common in younger patients and often during concomitant surgical procedures such as ligament reconstruction (ACL, PCL, etc). Please talk with your healthcare provider.

Meniscus transplant: Meniscus transplant is indicated for patients who have had a meniscus trimmed back in the past and may have continued issues down the line due to a lack of the meniscus, however the surfaces on the ends of the bones are still well-preserved. This is not common and the indication for this will be determined by your healthcare provider.